S717 Trends and Disparities in Mortality From Obesity-Associated Gastrointestinal Cancers in the United States, 1999–2020: A CDC WONDER Analysis

Introduction: The incidence of obesity-related cancers has increased markedly over the past 2 decades, paralleling the rise in obesity prevalence across the United States. Among these, gastrointestinal (GI) cancers have shown particularly strong associations with excess body weight. Monitoring mortality trends linked to these cancers is critical to understanding obesity’s long-term effects on cancer outcomes. Methods: We conducted a retrospective analysis of adults aged ≥25 years using CDC WONDER (1999–2020) to identify deaths co-listed with obesity (E66) and obesity-associated GI cancers, including malignancies of the esophagus (C15), stomach (C16), colon (C18), rectosigmoid junction (C19), rectum (C20), liver/intrahepatic bile ducts (C22), gallbladder (C23), and pancreas (C25). Age-adjusted mortality rates (AAMRs) per million were calculated, and trends assessed using Joinpoint regression by sex, race/ethnicity, region, and urbanization level. Results: From 1999 to 2020, AAMR for obesity-associated gastrointestinal (GI) cancers increased from 0.8 to 2.6 per million (average annual per cent change [AAPC]: +5.48%, confidence interval [CI]: +4.43 to +6.53, P < 0.001). A total of 7,232 deaths were recorded. Mortality rose steadily from 1999 to 2018 (APC: +4.45%, CI: +3.89 to +5.03, P < 0.001), followed by a sharper increase from 2018 to 2020 (APC: +15.67%, CI: +4.68 to +27.81, P = 0.006). AAMRs rose across all demographic and geographic subgroups. By 2020, men had a higher AAMR (3.3) than women (2.3). Non-Hispanic (NH) American Indian or Alaska Native individuals had the highest overall AAMR (2.6) followed by NH Black (1.9), NH Whites (1.5), Hispanics (1.2), NH Asian or Pacific Islander (0.3). The Midwest had the highest regional AAMR (1.7), followed by the West (1.6), South (1.4), and Northeast (1.2). Urbanization analysis showed greater mortality in non-metropolitan areas (AAMR = 2) compared to metropolitan areas (AAMR = 1.4). Although age-specific Joinpoint analysis could not be performed due to data variability, descriptive trends indicated increases across all adult age groups. Conclusion: Mortality from obesity-related GI cancers has more than tripled over 2 decades, with accelerated increases in recent years. The disparities across sex, race, region, and urbanization highlight a need for focused prevention. Strengthening obesity control measures, increasing early GI cancer screening, and enhancing equitable access to care should be central to national public health strategies.